EGG FREEZING FOR SOCIAL REASONS P. Patrizio, M.D., MBE, HCLD Yale University Fertility Center New Haven, CT-USA
Percentage of married, childless American women who experienced infertility problems for a Yearlong period Age 11 % 17 % 23 % 27 % Source: Center for Disease Control and Prevention/ National Center for Health Statistics, 2002 New York Times July 20, 2008
Martin JA et al. Births: Final data for 2009;National Vital Statistics Vol. 60(1) National Center for Health Statistics. 2011 Birth rates 20-24 y 25-29 y 30-34 y 35-39 y 40-44 y 45-49 2009 96/1000 110/1000 97.7/1000 46.5/1000 10.1/1000 0.7/1000 2008 103/1000 115/1000 99.3/1000 46.9/1000 9.8/1000 0.7/1000 Variation -7% declining last 20yrs -4% -2% ----- +1% increasing last 20 yrs ------ But was 0.3 in 1992
Fresh (non-donor) IVF Cycles 1999-2008 (CDC) Year Number of IVF Cycles/Ages <35 35-37 38-40 41-42 >42 Total Cycles 1999 29,682 15,291 12,848 5,302 2,628 65,751 2000 33,453 17,284 14,701 6,118 3,401 74,957 2001 35,984 17,791 16,283 7,044 3,762 80,864 2002 37,591 19,110 17,454 7,733 3,938 91,032 2003 39,852 20,056 18,660 8,185 4,279 91,032 2008 43,296 23,326 21,793 9,783 4,907 103,105 2004 40,853 21.019 19,174 8,487 4,709 94,242 % Change +45.8 +52.5 +69.6 +83.0 +86.2 +56.6
High Rates of Oocyte Wastage in ART Patrizio P & Sakkas D Fertil Steril (91): 1061-66, 2009 To determine the percentage of oocytes retrieved and fully utilized that do not produce a Live Birth Introduce the concept of Oocyte to Baby Rate (OBR) Oocyte Wastage = 1-[ Oocytes Retrieved / Infants delivered x 100]
Oocyte to Baby Rate (OBR) N Oocyte E.T. Frozen L.B. Fresh L.B. Frozen L.B. Oocyte, % E.T. (IR), % Donors 87 1705 193 372 80 37 6.8 22.0 <35 y 206 2917 546 295 105 20 4.3 15.6 35 37 y 116 1235 299 70 49 7 4.5 15.5 38 40 y 97 843 268 14 24 1 3.1 8.9 41 42 y 45 383 134 12 4 0 1.0 2.7 Total 464 5378 1247 391 182 28 4.0 13.0 Patrizio P, Sakkas D. Fertil Steril 2009;91:1061-1066.
Estimating Efficiencies in IVF (Tucker M et al. 2010) To expand on prior research (Patrizio & Sakkas 2009*) To quantify the oocyte/baby ratio (OBR) within a private program using a large patient data base All women undergoing oocyte retrieval for autologous IVF 2004-8 (5 years) 192,991 oocytes collected from 14,324 oocyte retrieval procedures * Fertil Steril 2009;91:1061-6
Babies per Oocyte (%) Total per Oocyte to Live Baby 7 6 5 4 3 2 1 0 Donor Oocyte Tucker, Levy et al, P-568 ASRM 2010 <35 35-37 38-40 41-42 43-44 Patient Age (Years)
Intellectual Background and Practical Obstacles Age Discrimination by Insurance and/or Government against Older Women By ART programs: Minimum Criteria for Egg Retrieval By ART programs: Protection of Program Results Lack of adequate information and Misperceptions
SOLUTION to the PROBLEM Postponement of Fertility by OOCYTE FREEZING
ONGOING IMPLANTATIONS AND BABY RATE PER VITRIFIED OOCYTE DURING THIRD PARTY REPRODUCTION USING AN EGG BANK P. Patrizio, M.D.,MBE 1, P.D. Bernal, DVM 2, J. Kahn, Bsc 2, C.C.Chang, Ph.D 2, D. Shapiro, M.D. 2 and P. Z. Nagy, M.D., Ph.D 2. ASRM, 67 th Annual Meeting, Oct 17, 2011, Orlando, Florida 1 Yale University Fertility Center,. New Haven, CT, USA 2 Reproductive Biology Associates, Atlanta, GA, USA
Objectives To investigate the ongoing oocyte to implantations and Oocyte to Baby Rate (OBR) in a donor/recipient program using cryopreserved banked oocytes Do oocytes banked by vitrification have a lower OBR than fresh oocytes?
Materials and Methods Time Period: July 2008 February 2011 Donation cycles: 88 donors (age 26.1)-112 cycles- 2078 MII oocytes banked and 1772 rewarmed Recipients: 290 (mean age 43.1) 4 to 8 eggs / Recipient
Summary Results Total oocytes Total Cryo MII Warmed Survived Fertiliz. Usable Embryo Embryo Transf. Ong/Del LBB Oocyte Recipient (n=290) Age 41.3 2078 1772 1559 (88%) 1169 (75%) 914 (59%) 519 (29%) 203/193 (70/66%) 11% MII 8% Tot. Mean - SD 6.1 1.8 5.3 1.4 3.1 1.3 1.8 0.5 Oocytes/ Embryo cryo 306 395 269-201 116 129/ 122 315 15% 12% Donors (n=88) Age 26.1 Retrieval (112) 2494 (GV,MI) Mean 22.2 Mean 18.5
COMPARISON OF OOCYTE CRYOPRESERVATION TECHNIQUES: A META-ANALYSIS D. Broomfield, MD, MBA, E. Vishwakarma, MD, L. Green, MD, P. Patrizio, M.D, MBE ASRM, 67 th Annual Meeting, Oct 17, 2011, Orlando, Florida
Materials and Methods Inclusion criteria: use of mature human oocytes fertilization via ICSI inclusion of pregnancy as an outcome Articles: Total number of articles analyzed: 240 Articles that met Criteria: 120 Vitrification method: 3,424 warmed eggs Slow Freezing method: 18,020 thawed eggs
Results Survival Rate/thawed oocyte Fertilization Rate/thawed oocyte Implantation Rate/thawed oocyte Pregnancy Rate/thawed oocyte Slow Freezing 71.9% [67.44, 75.89] 95% CI 51.2% [42.2,60.1] 95% CI 7% [4.3-11.2] 95% CI 4.2% [3.08, 5.56] 95% CI Vitrification 78.6% [70, 85.18] 95% CI 55.96% [47.4, 67.1] 95% CI 7.7% [5.35, 11] 95% CI 7.6% [4.98, 11.4] 95% CI
Material and Methods (Social freezing) 27 cycles (21 patients) cryopreserved for social reasons Mean age: 38 (range 31-42) Job classification: 8 businesswomen-4 MD- 3 teachers-2 psychologists-1 lawyer-1 minister-1 chemist-1 student.
Material and Methods (Social Freezing) Total of 231 oocytes cryopreserved 134 by slow freezing 97 by vitrification So far only one patient utilized oocytes (41 years old minister- now 43, with 13 oocytes slow freezing-9 (69%) survived-2 fertilized (22%)-no pregnancy)
NYU cycle data stratified by age (mean age:38; range: 23-42 y). n = 499 (2005-2010) Age (y) 34 (n = 41) 35-37 (n = 129) 38 (n = 329) P (anova) E2 day of OT (pg/ml±sd) 2612±1285 2416±1424 2248±1291.07 LH morning after LA OT (IU/L; range) pt n=22 126 (70-170) 109 (45-201) 90 (19-211) NS Number oocytes retrieved n (range) 21 (4-59) 17 (3-47) 14 (2-74).0001 Number MII oocytes retrieved and frozen n (range) Number MII per total number of oocytes Peak E2 per retrieved oocyte (pg/ml±sd) All values are means. 15 (2-35) 12 (1-36) 10 (1-55).0001 73% 74% 71% NS 153±81 162±83 196±118.001 Werner, Knopman, Arslan, Noyes, ISFP, 2011
Conclusions The majority of patients are older than 35 yrs Too early to assess see utilization rates The number of women that are using oocyte cryopreservation for fertility postponement is still low Since ASRM consider oocyte cryopreservation EXPERIMENTAL (!!), it cannot be advertised, patients are confused and insurances do not pay for it Time has come for ASRM to reappraise and remove the label
HOW MUCH to CHARGE? $13,000+ $500/y+ $5,000 at thawing